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<html lang="zh">
	<head>
		<meta charset="UTF-8" />
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		<link rel="stylesheet" type="text/css" href="../../css/global/public.css"/>
		<link rel="stylesheet" type="text/css" href="../../css/medication-consultation.css"/>
		<title>既往病史</title>
	</head>
	<body>
		<form id="historyOrder">
			<div class="mui-input-group font3">
				<div class="historyTitle">
					<p>病情描述</p>
					<textarea rows="5" placeholder="请详细描述您的症状，疾病和身体的状况，便于医生更准确的分析（必填，请输入10~500字）" name="description"></textarea>
				</div>
				<div class="mui-input-row">
					<label>诊断记录</label>
					<input type="text" placeholder="请输入(必填)" class="textR" name="diagnosticRecord">
				</div>
				<div class="mui-input-row">
					<label>医生姓名</label>
					<input type="text" placeholder="请输入(必填)" class="textR" name="doctorName">
				</div>
				<div class="mui-table-view-cell">
					<div class="mui-navigate-right">诊断日期 <i class="mui-pull-right historyTime">请选择诊断日期(必填)</i></div>
					<input type="hidden" name="diagnosticDate">
				</div>
				<div class="historyTitle" style="padding-bottom: 0.3rem;">
					<p>病例原件</p>
					<div class="upload camera-area">
						<ul class="thumb">
							<!-- 框-->
							<li class="addFile">
								<div class="add">
									<input type="file" accept="image/*" class="photos fileToUpload" id="fileToUpload" name="fileToUpload" onclick="javascript:this.value=''"/>
								</div>
							</li>
						</ul>
						<p class="font1">
							请上传病历原件，馨语会确保您的隐私安全
						</p>
					</div>
				</div>
			</div>
		</form>
		<div class="choice-doctorSubmit">
			<button class="submitOrder">提交</button>
		</div>
	</body>
	<!--公共方法-->
	<script type="text/javascript" src="../../js/common/common.js"></script>
	<script type="text/javascript" src="../../js/module/utilModule.js" ></script> 
	<!--配置信息-->
	<script type="text/javascript" src="../../js/common/config.js"></script>
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	<script type="text/javascript" src="../../js/electronicArchives/history-add.js" ></script> 
</html>
